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Texas' drop in uninsured rate might not last

2017-09-13 |
Houston Chronicle

Sept. 12--The notable drop in the rate of the people without health coverage in Texas and across the nation may feel like vindication for backers of the law known as Obamacare, but any victory lap is slowed by the uncertainty ahead.

The U.S. Census Bureau reported Tuesday that the rate of uninsured in Texas fell to 16.6 percent last year, down from 22.1 percent in 2013 when the Affordable Care Act's individual market plans first became available.

Overall, the nation's rate of uninsured dropped to 8.6 percent in 2016, down from 14.5 in 2013. That means that last year 91 percent of people had coverage, or about 320 million people nationally, according to the Census report.

"We were finally gaining traction," said Elena Marks, president and CEO of Houston's Episcopal Health Foundation, which focuses on health policy and access to care for the poor and uninsured.

She characterized the Census figures as "real and consistent improvement year after year -- something that had not previously happened in Texas for a very long time."

Still, she worried about the toll from the divisive politics that surrounds all things about the health-care law, including declarations from the White House that the law was a "big, fat, ugly lie" that was deeply hurting people in the country.

While the Republican-led U.S. House narrowly passed a measure to dismantle major provisions of the law and replace it with one of their own, the Senate was unable to pass its version. The congressional fate of the law remains in limbo.

Marks said Tuesday that all of the fiery rhetoric, as well as a series of internal measures by the current administration to undercut the law from within, could stall additional progress.

A Gallup-Sharecare Well-Being Index this summer showed that the uninsured rate was starting to tick up in the first two quarters of this year.

It is unclear whether the slight increases were a blip or a harbinger of things to come.

Merrill Matthews, resident scholar at the Institute for Policy Innovation, a conservative think tank in Irving, said he was pleased that the rate of uninsured in Texas had dropped.

Still, he remains opposed to Obamacare.

"They did achieve a decline in the uninsured, but they did it in the worst possible way," he said.

Matthews said he also thinks merely reporting uninsured rates does not tell the whole story as many who gained insurance have been unable to use it because of high deductibles and other out-of-pocket costs they cannot afford.

Under the current law, most everyone is required to carry health insurance. But every replacement plan introduced so far has included scrapping that requirement.

While Congress has been unable to repeal and replace the current law legislatively, that does not mean another type of dismemberment appears to be underway.

President Donald Trump's first official action after inauguration was to direct federal agencies to discontinue any policies that regulate or carry out provisions of the health-care law. So far that has included pulling advertisements reminding people to sign up for coverage right before this year's enrollment ended and the Internal Revenue Service announcing it would no longer reject returns that did not included proof of coverage.

Also, the U.S. Health and Human Services Department, which oversees the law, has cut by half the enrollment period for 2018, launched a social media campaign featuring people who say they were harmed by the law, and canceled contracts to companies that have helped in sign-up efforts and outreach in past years.

At the same time, many insurers have dropped out of the federal exchanges, leaving fewer options for customers. Insurance companies have announced significant rate increases for 2018 in the individual market, some blaming the uncertainty blanketing their industry which leaves them with little choice but to inflate rate increase requests to build in a cushion.

Most people in the country get their insurance through their employer.

Health policy watchers are concerned that people in the more volatile individual market are left confused by the political posturing and may skip buying coverage altogether next year -- which could create a spike in uninsured rates.

This is especially difficult for Texas, which continues to lead the nation in the uninsured. According to the Census report the state's 16.6 percent rate is close to exactly double the national rate.

While progress in Texas is undeniable, it falls well short of states that expanded Medicaid under the law. For instance, California recorded a 9.8 percent drop in its uninsured rate, the Census report showed. New Mexico and Kentucky had 9.5 and 9.2 percent declines, respectively.

The enrollment period for 2018 begins Nov. 1 and runs through Dec. 15.

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